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Apical Thrombus Mimicking Ventricular Septal Rupture
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J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00045. Epub March 11, 2024.
A 51-year-old man with chest pain was admitted to the emergency department. The patient was taken to the coronary angiography lab with a diagnosis of inferior myocardial infarction. The right coronary artery (RCA) was found to be totally occluded. A drug-eluting stent was implanted, and revascularization was achieved (Figure 1A and B). Post-procedure echocardiography (ECHO) showed a suspicious appearance consistent with ventricular septal rupture in the apical septum region (Figure 1C and D; Video). The patient was hemodynamically stable and cardiac magnetic resonance imaging (MRI) was performed. Cardiac MRI revealed aneurysmatic enlargement in the cardiac apical region and a 58 x 14-mm thrombus surrounding the wall of the aneurysm much like a rim (Figure 2A and B). The patient was administered warfarin, an oral vitamin K antagonist, and was anticoagulated. At 2-month follow-up, we performed a control cardiac MRI and determined that the thrombus had significantly regressed (Figure 2C and D).
Ventricular septal rupture (VSR) is a life-threatening mechanical complication of acute myocardial infarction and is associated with high mortality.1,2 Although the frequency of primary percutaneous coronary intervention has increased, its incidence is still approximately 0.25% in cases with acute coronary syndrome.3 Although percutaneous closure devices offer alternative treatments, surgery remains the standard treatment for VSR after acute coronary syndrome.4 Left ventricular thrombus is common in patients with apical aneurysm and is a serious risk factor for cardioembolic stroke.5 It is very rare for left ventricular apical aneurysm and thrombus to mimic VSR. Transesophageal echocardiography or cardiac MRI can be used in the differential diagnosis. In our case, a differential diagnosis was made with cardiac MRI imaging. In addition, we began anticoagulant therapy, which was stated to be the gold standard in the treatment of left ventricular thrombus.6
Affiliations and Disclosures
From the Department of 1Cardiology and 2Radiology, Trakya University Faculty of Medicine, Edirne, Turkey.
Informed consent statement: Informed consent was obtained from all individual participants included in the study, and patient consent was provided for publication of the images used herein.
Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.
Address for correspondence: Cihan Öztürk, Trakya University Faculty of Medicine, Department of Cardiology, 22030 Balkan Yerleşkesi, Edirne, Turkey. Email: dr.cihanozturk@gmail.com
References
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6. McCarthy CP, Vaduganathan M, McCarthy KJ, Januzzi JL, Bhatt DL, McEvoy JW. Left ventricular thrombus after acute myocardial infarction: screening, prevention, and treatment. JAMA cardiology. 2018;3(7):642-649. doi: 10.1001/jamacardio.2018.1086
